Global economic meltdown and healthcare financing in Ghana
Authors: Mubarick N. Asumah, Abdulai Abubakari, Mubaric Yakubu, Bijaya K. Padhi
Journal: International Journal of Surgery (2023)

Without proper and consistent revenue and income streams to pay for healthcare, achieving this global universal health coverage aim is practically impossible1. However, current attempts to model, operationalize, and ensure that there is a uniform financial structure that would not discriminate against residents but assure the greatest value by all citizens have made funding healthcare a struggle for many developing nations. Ghana is one of the first countries in sub-Saharan Africa to begin establishing a National Health Insurance Scheme (NHIS). The ACT 650 (now Act 852) replaced the 'cash and carry system' (out-of-pocket payments). The goal of implementing such a policy at this time in the nation's history was to create an atmosphere that would help remove obstacles to receiving high-quality medical treatment care without prejudice2. The NHIS was designed to cover everyone by 2010 after its introduction in 2003 to adequately protect Ghanaians from out-of-pocket payments for acceptable quality health services. The utilization of health services at all levels of healthcare in Ghana has dramatically increased as a result of the implementation of the NHIS. For instance, according to Sarkodie3, signing up for Ghana's NHIS results in a 26% increase in healthcare consumption and a 4% decrease in out-of-pocket expenses. However, despite citing a variety of excuses, around 48% of the population is still not enrolled in the NHIS. About 30% of those who had already enrolled had left for a variety of reasons3. However, there have been innumerable examples of service providers receiving delayed claims reimbursement4. The difficulties with health insurance in Ghana's healthcare system were attributed to the poorly managed bureaucracy causing leaks and delays in processing claims, which also makes it challenging for claims to be properly paid4,5. All accredited medical institutions in Ghana are required by the NHIS to treat covered patients and subsequently submit claims for reimbursement6. Despite the fact that the NHIS faces numerous administrative, financial, and other difficulties5, the scheme exempts special groups, including the elderly over the age of 70 and those with mental health conditions, from full payment6,7. The program also featured free maternal health care, which entitles all expectant women to a free membership with the NHIS and free treatment for the duration of their pregnancies, deliveries, and the first 3 months following childbirth8. In Ghana, the stakeholders in health care delivery include the Ministry of Health, which give policy direction, the Ghana Health Service, and the Christian Health Association of Ghana deliver health care services5. Also, the pharmaceutical societies in Ghana play a pivotal part in the processes of care delivering through the prompt delivering of medications and medical supplies for the proper functioning of the health care facilities5. In Ghana, copayments are illegal under the current ACT 852. Following the coronavirus disease 2019 pandemic and the Ukraine–Russia misunderstanding, there have been serious consequences for many economies including Ghana. This has increased the cost of doing business with very skyrocketing inflation and duties on goods in general. On 20 October 2022, a joint press release including the Ghana National Chamber of Pharmacy, Pharmaceutical Association of Ghana, and the Pharmaceutical Importers and Wholesalers Association of Ghana indicated they were no longer going to supply drugs to health facilities unless there is cash at hand. Unfortunately, Ghana's health institutions rely on government health insurance payments. The quality of healthcare service is compromised as a result of payment delays since the affected institutions are unable to function with inadequate funding. Reimbursement of claims is marked by delays, which can occasionally exceed 6 months8. According to the joint press release, currently the government of Ghana has delayed payment of NHIS claims for over 9 months. Already the Ghana Medical Association has expressed serious worry about a possible collapse of Ghana's NHIS if the government does not step in to meet the demands of the stakeholders9. Despite the seeming challenges, these facilities cannot stop running due to NHIS indebtedness; they must survive. As such, some facilities, therefore, resort to asking clients to pay some amounts known as top-ups. The consequences of out-of-pocket payment are dire and could lead to most clients resorting to self-medication and self-diagnosis, which will subsequently worsen their plight, among others. This phenomenon would lead to inequalities in access to health care services as only those who can afford these top-ups will seek healthcare in recognized institutions. The NHIA scheme has resulted in clients losing confidence in the health system, particularly health care providers, since clients believe that people who are able to pay to receive the best treatment. Consequently, this has a tendency to widen the health inequality gap and could thwart the country's efforts toward universal health coverage as well as the realization of the Sustainable Development Goal 3. Ethical approval and informed consent Ethical approval and informed consent were not required for this study. Sources of funding There was no source of funding for this research. Author contribution M.N.A., M.Y., and A.A.: conceptualization; A.A. and B.K.P.: validation; M.N.A. and M.Y.: resources; M.N.A. and M.Y.: writing – original draft preparation; B.K.P. and A.A.: writing – review and editing; A.A., B.K.P., and M.N.A.: visualization; A.A. and B.K.P.: supervision. All authors have read and agreed to the published version of the manuscript. Conflicts of interest disclosure The authors declare no conflicts of interest. Guarantor M.N. Asumah and A. Abubakari. Data availability Data sharing does not apply to this article as no new data were created.